Shoulder Dystocia Debrief

It’s not just about the mechanics, it’s also about the nervous system.

Today I was thinking about what resources we have as midwives to work through difficult birth experiences.  Some of these difficult experiences may be where everything turned out completely fine and yet the mortality and humility of birth met for a moment and left a lasting imprint.  

A person might even find themselves waking at night thinking about a birth that they attended and replaying moments over and over.  I think this is where we can bring practical tools of trauma informed listening skills alongside reflecting on the birth for both intuitive skills and practical skills in resolving a shoulder dystocia.  

I believe we time travel regularly and that there are possibilities for lessons for the future as well as potential compassionate witnessing of the past when we attend to these moments.  As someone who has been trained in Birth Story Listening, I have thought about this over the years.  As a midwife, these moments are my teachers not only about attending births to be a better midwife but in the diving within to understand the deeper aspects of who we are and our belief systems.  

The truth be told is that as midwives we are also attending births and bringing our skills for resolution of emergent situations with us.  Knowing normal is imperative and restoration of the mechanisms of birth is a lifesaving skill.  And what we know about shoulder dystocias is that some are easier than others.  In this way, most of the time, we learn from smaller situations and then are able to attend harder ones.  Each step of the way is a step of humility.  It may not look graceful, and if it does, the outside may not be reflecting the inside.  

So how do we do a quality shoulder dystocia debrief?

We must start with the nervous system and the belief systems affecting the midwife in this particular moment.  How are they affecting their relationship with other clients or births or even of themselves?  How did you know what to do?  

It is also in these moments that we can return to the basics of our craft and begin asking questions about what we may have felt in our bodies before we even arrived at the birth.  When did you suspect something was going on and what did that feel like in your body?  This is how we develop intuition and upon review of our insider experience we can learn intuition or at the very least more about the nervous system.  

Yet, there is also the aspect of attending to the nervous system through the mechanics of this particular shoulder dystocia.  Where were the shoulders?  Could you find them or were they or just one of them caught?  What was the diameter of them?  On what part of the birthgiver’s body was the baby caught?  Was it on the pelvis or soft tissues?  What did you do next?  How did you know to do that?  Did it make a difference?  

What did you do to free the shoulder/ shoulders?  Did you reduce the diameter of the baby?  Did you help with positioning to open the space where the baby was stuck?  Did you use gravity and movement for release?  Did you use specific positions so you could use your body weight for more rotational force?  Did you dis-impact the baby in any way?  Did the baby have an arm behind its back?  Did you have signs of this ahead of time?  

All of these questions don’t stand alone.  They may be rabbit holes or they may not go anywhere and that is okay.  We find the relevance for a birthworker and debriefing is not soul-less activity.  Debriefing is a communing with a nervous system from the past, present and future.  It can be a doorway to someone understanding more about themselves and their process.  It is a pathway of validation of the skills and understanding of that moment even if there was a bad outcome.  

Birthworkers are not afraid of hard work.  And we know that often trauma isn’t dealt with appropriately and, yes, we work to do better or differently next time, but it doesn’t mean that our experience may be driven by agreements or belief systems that do not serve us for the next time we attend someone.  

And then, will you attend this person’s next birth?  Why?  Why not?  What do you know now that you didn’t know before?  What might they know now that they didn’t know before.  

In the end, as we pull together the session of working with both the inner and outer experience and inner and outer mechanicw that we can anchor our new knowings about ourselves, about the body, and about ways we show up for emergencies. Maybe it is through journalling, art, communing with nature, bodywork,  fashioning a necklace or card that you keep with you so that you remember this new knowing as you look at it on the wall of your office or in your birth bag.  

In any case, it seems straight forward to debrief a shoulder dystocia and its mechanics by looking at the relationship of the baby to the body, but it is when we look to the nervous systems of those who were involved and how they affect them NOW that the art of debriefing becomes more complex.  In valuing the nervous systems, we improve our care for more than just the next shoulder dystocia but for all of our births.

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